Severe Pre Eclampsia: intrauterine growth restriction and perinatal outcome in preterm gestations
Preeclampsia severa: restricción del crecimiento intrauterino y desenlaces perinatales en gestaciones pretérmino
Show authors biography
Objective: to describe frequency of perinatal complications in preterm gestations associated to severe preeclampsia, with or without intrauterine growth restriction (IUGR). Materials ami methods: this is a descriptive study of single pregnancies, severe preeclampsia and preterm birth between weeks 24 and 34, with and without IUGR, conducted between January 2007 and December 2009. Fetal monitoring was conducted every 48 hours, fetal biophysical profile testing (BPP) twice a week and fetal and placental Doppler every week. R sults: 55 patients with mean age 29.6 (SD 6.4) years were assessed; mean gestational age was 29.9 (SD 2.9) weeks, lower in the group with IUGR (28.8 (SD.3.1) vs 31.2 (SD 2.0)). IUGR was present in 30 (54.5%) pregnancies. Perinatal death occurred in 17 cases (31%) 15 with IUGR. Most perinatal deaths occurred in pregnancies of less than 28.6 weeks. Conclusions: perinatal mortality rate in preeclampsia in early gestational age is high in our hospital, especially associated with IUGR. This association may act in a synergic manner on complications caused by prematurity. We expect better perinatal results as we improve prenatal and neonatal care delivery.
Article visits 3148 | PDF visits 908
Downloads
1. Cifuentes R. Hipertensión arterial y embarazo. En: Obstetricia de alto riesgo. 4° ed. Colombia: Aspromédica; 1994. p. 525-61O.
2. Huppertz B. Placenta! origins of preeclampsia challenging the curren! hypothesis. Hypertension. 2008; 51(4): 970-5.
3. Sibai BM, Mercer BM, SchiffE, Friedman SA.Aggressive versus expectant management ofsevere preeclarnpsia at 28 to 32 weeks' gestation: a randornized controlled tria!. Am J Obstet Gynecol. 1994; 171 (3):818-22.
4. Odendaal HJ, Pattinson RC, et al.Aggressive or expectant management of patients with severe preeclampsia between 28-34 weeks' gestation: a randomized controlled tria!. Obste! Gynecol. 1990; 76(6): 1070-4."
5. ACOG technical bulletin. Hypertension in pregnancy. Number 219 January. Committee on Technical Bulletins oftheAmerican College ofObstetricians and Gynecologists. lnt J Gynaecol Obste!. 1996 May;53(2):175-83
6. Chammas MF, Nguyen TM, Li MA, Nuwayhid BS, Castro LC. Expectant management ofsevere pretenn preeclampsia: is intrauterine growth restriction an indication for immediate delivery?. Am J Obste! Gynecol. 2000; 183(4):853-8.
7. Schiff E, Friedrnan SA, Sibai BM. Conservative management of severe preeclampsia remate from term. Obstet Gynecol. 1994; 84(4): 626-30.
8. Shear RM, Rinfret D, Leduc L. Should we offer expectant management in cases of severe preterrn preeclampsia with fetal growth restriction?. Arn J Obstet Gynecol. 2005;192(4):1119-25.
9. Ganzevoort W, RepA, Bonsel GJ, Fetter WPF, van Sonderen L, De Vries n, et al.Arandomised controlled tria! comparing two temporisingmanagement strategies, one with and one without plasma volume expansion, for severe and early onset pre-eclampsia. BJOG. 2005; 112(1 O): 1358-68.
10. Figueras F, Gratacós E. Alteraciones del crecimiento fetal. En: Medicina fetal. Buenos Aires: Editorial médica panamericana; 2007.
11. Von Dadelszen P, Magee LA, Roberts JM. Subclassification ofpreeclampsia. Hypertens Pregnancy. 2003;22(2):143-148.
12. Haddad B, Kayem G, Deis S, Sibai BM. Are perinatal and maternal outcomesdifferent during expectant management ofsevere preeclampsia in the presence of intrauterine growth restriction?. Am J Obstet Gynecol. 2007; 196(3):237 el-237.e5.
13. Bombrys AE, Barton JR, Nowacki EA, et al. Expectant management ofsevere preeclampsia at less than 27 weeks' gestation: maternal and perinatal outcomes according to gestational age by weeks at onset of expectant management. Am J Obstet Gynecol. 2008; 199(3): 247.el- 247.e6